IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v285y2021ics0277953621006092.html
   My bibliography  Save this article

Understanding the maternal and child health system response to payment for performance in Tanzania using a causal loop diagram approach

Author

Listed:
  • Cassidy, Rachel
  • Tomoaia-Cotisel, Andrada
  • Semwanga, Agnes Rwashana
  • Binyaruka, Peter
  • Chalabi, Zaid
  • Blanchet, Karl
  • Singh, Neha S.
  • Maiba, John
  • Borghi, Josephine

Abstract

Payment for performance (P4P) has been employed in low and middle-income (LMIC) countries to improve quality and coverage of maternal and child health (MCH) services. However, there is a lack of consensus on how P4P affects health systems. There is a need to evaluate P4P effects on health systems using methods suitable for evaluating complex systems. We developed a causal loop diagram (CLD) to further understand the pathways to impact of P4P on delivery and uptake of MCH services in Tanzania. The CLD was developed and validated using qualitative data from a process evaluation of a P4P scheme in Tanzania, with additional stakeholder dialogue sought to strengthen confidence in the diagram. The CLD maps the interacting mechanisms involved in provider achievement of targets, reporting of health information, and population care seeking, and identifies those mechanisms affected by P4P. For example, the availability of drugs and medical commodities impacts not only provider achievement of P4P targets but also demand of services and is impacted by P4P through the availability of additional facility resources and the incentivisation of district managers to reduce drug stock outs. The CLD also identifies mechanisms key to facility achievement of targets but are not within the scope of the programme; the activities of health facility governing committees and community health workers, for example, are key to demand stimulation and effective resource use at the facility level but both groups were omitted from the incentive system. P4P design considerations generated from this work include appropriately incentivising the availability of drugs and staffing in facilities and those responsible for demand creation in communities. Further research using CLDs to study heath systems in LMIC is urgently needed to further our understanding of how systems respond to interventions and how to strengthen systems to deliver better coverage and quality of care.

Suggested Citation

  • Cassidy, Rachel & Tomoaia-Cotisel, Andrada & Semwanga, Agnes Rwashana & Binyaruka, Peter & Chalabi, Zaid & Blanchet, Karl & Singh, Neha S. & Maiba, John & Borghi, Josephine, 2021. "Understanding the maternal and child health system response to payment for performance in Tanzania using a causal loop diagram approach," Social Science & Medicine, Elsevier, vol. 285(C).
    • Handle: RePEc:eee:socmed:v:285:y:2021:i:c:s0277953621006092
    DOI: 10.1016/j.socscimed.2021.114277
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953621006092
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.socscimed.2021.114277?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Mayumana, Iddy & Borghi, Jo & Anselmi, Laura & Mamdani, Masuma & Lange, Siri, 2017. "Effects of Payment for Performance on accountability mechanisms: Evidence from Pwani, Tanzania," Social Science & Medicine, Elsevier, vol. 179(C), pages 61-73.
    2. David C. Lane & Özge Pala & Yaman Barlas & Tuğrul Meker & Yaman Barlas, 2015. "Dynamic Consequences of Performance-Based Payment Systems in Public Hospitals," Systems Research and Behavioral Science, Wiley Blackwell, vol. 32(4), pages 459-480, July.
    3. Schaffernicht, Martin & Groesser, Stefan N., 2011. "A comprehensive method for comparing mental models of dynamic systems," European Journal of Operational Research, Elsevier, vol. 210(1), pages 57-67, April.
    4. Peter Binyaruka & Edith Patouillard & Timothy Powell-Jackson & Giulia Greco & Ottar Maestad & Josephine Borghi, 2015. "Effect of Paying for Performance on Utilisation, Quality, and User Costs of Health Services in Tanzania: A Controlled Before and After Study," PLOS ONE, Public Library of Science, vol. 10(8), pages 1-16, August.
    5. Singh, Neha S. & Kovacs, Roxanne J. & Cassidy, Rachel & Kristensen, Søren R. & Borghi, Josephine & Brown, Garrett W., 2021. "A realist review to assess for whom, under what conditions and how pay for performance programmes work in low- and middle-income countries," Social Science & Medicine, Elsevier, vol. 270(C).
    6. Rashwan, Wael & Abo-Hamad, Waleed & Arisha, Amr, 2015. "A system dynamics view of the acute bed blockage problem in the Irish healthcare system," European Journal of Operational Research, Elsevier, vol. 247(1), pages 276-293.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Osei Afriyie, Doris & Loo, Pei Shan & Kuwawenaruwa, August & Kassimu, Tani & Fink, Günther & Tediosi, Fabrizio & Mtenga, Sally, 2024. "Understanding the role of the Tanzania national health insurance fund in improving service coverage and quality of care," Social Science & Medicine, Elsevier, vol. 347(C).

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Laura Anselmi & Julius Ohrnberger & Eleonora Fichera & Pedroso Nhassengo & Quinhas F. Fernandes & Sergio Chicumbe, 2023. "The impact of performance‐based financing within local health systems: Evidence from Mozambique," Health Economics, John Wiley & Sons, Ltd., vol. 32(7), pages 1525-1549, July.
    2. Singh, Neha S. & Kovacs, Roxanne J. & Cassidy, Rachel & Kristensen, Søren R. & Borghi, Josephine & Brown, Garrett W., 2021. "A realist review to assess for whom, under what conditions and how pay for performance programmes work in low- and middle-income countries," Social Science & Medicine, Elsevier, vol. 270(C).
    3. Dimitri Renmans & Nathalie Holvoet & Bart Criel, 2017. "Combining Theory-Driven Evaluation and Causal Loop Diagramming for Opening the ‘Black Box’ of an Intervention in the Health Sector: A Case of Performance-Based Financing in Western Uganda," IJERPH, MDPI, vol. 14(9), pages 1-20, September.
    4. Geeske Scholz & Martina Austermann & Kai Kaldrack & Claudia Pahl-Wostl, 2015. "Evaluating group model building exercises: a method for comparing externalized mental models and group models," System Dynamics Review, System Dynamics Society, vol. 31(1-2), pages 28-45, January.
    5. Federico Cosenz & Guido Noto, 2016. "Applying System Dynamics Modelling to Strategic Management: A Literature Review," Systems Research and Behavioral Science, Wiley Blackwell, vol. 33(6), pages 703-741, November.
    6. Thompson, James P. & Howick, Susan & Belton, Valerie, 2016. "Critical Learning Incidents in system dynamics modelling engagements," European Journal of Operational Research, Elsevier, vol. 249(3), pages 945-958.
    7. Schaffernicht, Martin F.G. & Groesser, Stefan N., 2014. "The SEXTANT software: A tool for automating the comparative analysis of mental models of dynamic systems," European Journal of Operational Research, Elsevier, vol. 238(2), pages 566-578.
    8. Alberto Sardi & Enrico Sorano, 2019. "Dynamic Performance Management: An Approach for Managing the Common Goods," Sustainability, MDPI, vol. 11(22), pages 1-22, November.
    9. Mayumana, Iddy & Borghi, Jo & Anselmi, Laura & Mamdani, Masuma & Lange, Siri, 2017. "Effects of Payment for Performance on accountability mechanisms: Evidence from Pwani, Tanzania," Social Science & Medicine, Elsevier, vol. 179(C), pages 61-73.
    10. David C. Lane & Özge Pala & Yaman Barlas & David C. Lane & Özge Pala & Yaman Barlas, 2015. "Health, Demographic Change and Well-Being: The European Union's Horizon 2020 Programme and System Dynamics," Systems Research and Behavioral Science, Wiley Blackwell, vol. 32(4), pages 407-413, July.
    11. Federico Barnabè & Maria Cleofe Giorgino & Martin Kunc, 2019. "Visualizing and managing value creation through integrated reporting practices: a dynamic resource-based perspective," Journal of Management & Governance, Springer;Accademia Italiana di Economia Aziendale (AIDEA), vol. 23(2), pages 537-575, June.
    12. Carter, Michael W., 2018. "High-fidelity whole-system patient flow modeling to assess health care transformation policiesAuthor-Name: Esensoy, Ali Vahit," European Journal of Operational Research, Elsevier, vol. 266(1), pages 221-237.
    13. Fang, Debin & Zhao, Chaoyang & Yu, Qian, 2018. "Government regulation of renewable energy generation and transmission in China’s electricity market," Renewable and Sustainable Energy Reviews, Elsevier, vol. 93(C), pages 775-793.
    14. Elsawah, Sondoss & McLucas, Alan & Mazanov, Jason, 2017. "An empirical investigation into the learning effects of management flight simulators: A mental models approach," European Journal of Operational Research, Elsevier, vol. 259(1), pages 262-272.
    15. Jaén, Sebastián, 2024. "The decrease of ED patient boarding by implementing a stock management policy in hospital admissions," Operations Research Perspectives, Elsevier, vol. 12(C).
    16. Jaime González & Juan-Carlos Ferrer & Alejandro Cataldo & Luis Rojas, 2019. "A proactive transfer policy for critical patient flow management," Health Care Management Science, Springer, vol. 22(2), pages 287-303, June.
    17. Maria Cleofe Giorgino & Federico Barnabè & Martin Kunc, 2020. "Integrating qualitative system dynamics with accounting practices: The case of integrated reporting and resource mapping," Systems Research and Behavioral Science, Wiley Blackwell, vol. 37(1), pages 97-118, January.
    18. David C. Lane & Özge Pala & Yaman Barlas & Özge Pala, 2015. "Pay-for-performance Plans," Systems Research and Behavioral Science, Wiley Blackwell, vol. 32(4), pages 481-484, July.
    19. Raffaele Giordano & Marcela Brugnach & Irene Pluchinotta, 2017. "Ambiguity in Problem Framing as a Barrier to Collective Actions: Some Hints from Groundwater Protection Policy in the Apulia Region," Group Decision and Negotiation, Springer, vol. 26(5), pages 911-932, September.
    20. Karlijn L. van den Broek & Sina A. Klein & Joseph Luomba & Helen Fischer, 2021. "Introducing M‐Tool: A standardised and inclusive mental model mapping tool," System Dynamics Review, System Dynamics Society, vol. 37(4), pages 353-362, October.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:285:y:2021:i:c:s0277953621006092. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.